A Mayo Model: The Collaborative Future of Medicine

With affiliations, which don't require significant capital investments, Mayo has plenty of money to invest in new medical services technologies, such as
proton beam accelerators going up in Arizona and Minnesota, other experts note.

The vehicle for those affiliations is the year-old Mayo Clinic Care Network, which now includes seven members and is poised to expand further. Current
members are NCH Healthcare System of Naples, FL; Dartmouth-Hitchcock of Lebanon, NH; Altru Health System of Grand Forks, ND; Arizona State University
Health Services of Tempe, AZ.; Heartland Health of St. Joseph, MO; Kingman Regional Medical Center of Kingman, AZ; and Sparrow Health System of
Lansing, MI.

"My vision is that we're going to have 15 major (healthcare) systems
in this country."

Affiliated physicians get the ability to consult electronically with Mayo specialists about patients who are difficult to diagnose or treat, usually within
about 24 hours. (Clinical information is shared electronically through a custom-designed, web-based system, and if physicians need to talk they do so.)
Essentially, these patients go to the front of the line, ahead of other people seeking Mayo Clinic consultations. Plans call for shortening the timeframe
even further. "We're working on real-time e-consults," says Mary Jo Williamson, the network's administrative director.

The relationships don't revolve around securing a steady stream of patients for Mayo from other health systems, officials say. "They haven't been
aggressive about pushing referrals," says Brian Turney, chief executive of Kingman Regional, which has brought six Mayo-trained radiologists onto its staff
since announcing the affiliation last October.

Altru Health System is actually sending fewer patients to Mayo's medical campus in Rochester, 400 miles away, than it had before the affiliation. "We're
bringing Mayo Clinic knowledge and expertise here instead of patients having to go there to get it," says Dennis Reisnour, chief planning executive of
Altru, which owns an acute care hospital, a rehabilitation hospital and more than a dozen clinics in the Grand Forks region.

Choosing whom to affiliate with is important, and Mayo staff carefully vet candidates to determine if they're financially stable, well run, and if their
values and medical culture are compatible. While affiliates can advertise the relationship, they can't claim they're officially part of the Mayo Clinic.
(That designation is reserved for facilities Mayo owns and operates.) Altru hopes the arrangement will allow it to remain independent and "continue to do
better in a changing world without being owned by a bigger provider," Reisnour says.

In exchange, "we would hope that they will think of us if a complex patient needs to leave the community," says Dr. David Hayes, medical director of the
Mayo Clinic Care Network.

Also, affiliates get access to AskMayoExpert, an extensive Mayo-created database that includes so-called "care pathways" spelling out what should be done,
when, and how for patients with various medical conditions. And they receive consulting services from Mayo experts on matters such as improving patient
satisfaction, creating better systems to monitor quality care, or building medical teams that collectively manage patients.

For example, Arizona's Kingman Regional Medical Center has started employing more physicians, and it wants them to better coordinate medical services. Mayo
pioneered integrated, team-based care, and several of its doctors are advising Kingman about strengthening physician leadership.

But collaborations work both ways, and Mayo stands to be benefit from them as well. The clearest example of that is Mayo's recent affiliation with
Dartmouth-Hitchcock, an academic medical center known for groundbreaking studies of varying medical practice patterns and their impact on the health of
large populations. Both organizations are members of the High Value Healthcare Collaborative, a group of major medical centers established last year to
share data about medical practices and outcomes.

"We can help (Mayo) on the analytic side because our expertise is how you look at populations and measure outcomes, the value of care, and the cost of
care. And they can help us learn about the science of execution in the delivery of healthcare," said Dr. James Weinstein, Dartmouth-Hitchcock's president
and chief executive.

Dr. Weinstein's view of the future and the potential of this collaboration is radical. "My vision is that we're going to have 15 major (healthcare) systems
in this country," he says. "We can't support 5,000 hospitals, all of them doing their own thing."

Still unresolved is whether Mayo will join with its affiliates in accountable care organizations or other new structures being promoted under the federal
health law to care for patients while assuming financial risk. Officials say that's not the goal of the Mayo Clinic Care Network, but they don't rule out
the possibility altogether.

"Let's face it: We don't know where this is going to go, but this gives us more flexibility in terms of figuring out how to work in this new environment,"
says Dr. Noseworthy, Mayo's chief executive. Of more immediate importance, he says, is "learning from affiliates and sharing with them our best knowledge"
as new models of medical care are developed.

The point is echoed by the Cleveland Clinic as well. With affiliations, that Ohio-based organization can expand its research efforts and clinical trials to
a broader population, says DeGrandis, chair of its community partnerships. "As you provide more and more service in a clinical area, there's more and more
learning, and the opportunity to provide that care more effectively increases."

This story was produced in association with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family
Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Judith Graham is a writer whose work has appeared in the Chicago Tribune, where she was a senior health-care reporter, as well as the TheNew York Times and TheWashington Post. She is currently a mental-health reporting fellow with the Carter Center in Atlanta.